Understanding regional chemotherapy
For many cancer patients and their families, the concept seems like common-sense medical science.
Regional chemotherapy targets the cancerous cells or tumour directly, rather than seeping through the entire body as does traditional, systemic chemotherapy given intravenously. So, why isn’t regional chemotherapy widely available in Canada?
It is used at special cancer centres here, for certain types of cancer. For example, Sunnybrook Hospital in Toronto offers regional chemo for secondary cancer in the liver that began with colorectal cancer. Patients with breast cancer that spreads to the liver (and often to the bones and lungs) are not eligible for that type of treatment. There is also a heat chemotherapy treatment offered at Mount Sinai Hospital in Toronto.
Rebecca Auer, director of cancer research at the Ottawa Hospital Research Institute, says there is not substantive evidence from clinical trials to expand the reach of regional chemotherapy for other types of cancer, including metastatic breast cancer.
From a public health perspective, Auer adds, the science suggests the proportion of patients who will improve with it is not high enough in the general population relative to the costs and the health risks involved. Auer doesn’t deny there is strong anecdotal evidence the expensive therapy works for certain highly motivated patients.
“Hope is probably the most important piece of medicine we miss sometimes,” Auer says. “When patients aren’t ready to give up, having hope and pursuing other options probably yields better results.”
Scores of Canadian patients are spending tens of thousands of dollars, or more, for regional chemo sessions in Germany or elsewhere, hoping for a precious extension of life.
HOW IT WORKS
Regional chemotherapy aims to target the tumour while limiting side-effects, such as nausea.
Medication is administered (via a catheter) into the arteries that supply the tumour region with blood. Following treatment, the blood is washed out by chemofiltration and the excess medication is removed (to limit side-effects).
In a YouTube video, Dr. Karl Aigner of the Medias Klinikum in Burghausen, Germany, explained — threefold — why it can be complicated for an oncologist to perform regional chemotherapy.
“The problem is, when you perform regional chemotherapy, you have to be a vascular surgeon,” Aigner said. “Second, you have to know a lot about pharmacology — which drug and which concentration. A surgeon doesn’t know this, and when I started, I don’t know it, either. Third, you have to be an interventional radiologist, you have to know where to place the catheters angiographically.
“When you have experience in all those three fields, you can do regional chemotherapy ... and this is what we do.”